Your Digest for Sunday, Mar 31, 2024 05:59 PM


[!TIP] Mnemonic:
LPFB - P looks like R -> Right axis deviation
LAFB - LA - Left Axis Deviation
LBBB - also left axis deviation
LeftPosteriorFascicularBlockMnemonicRAD.png


| Causes Left Axis Deviation | No effect on axis |
| Affects MI diagnosis | No effect on MI diagnosis|
| Best seen in V6 - M pattern| Best see in V1 - RSR pattern|
the 'best seen' lead views the heart from the same side as the blocked bundle.

[!INFO] Shortcut to diagnosing BBBs
Another simple way to diagnose a left bundle branch in an ECG with a widened QRS complex (> 120 ms) would be to look at lead V1.

[!INFO] ECG criteria for LBBB:

  1. QRS duration greater than 120 milliseconds
  2. Absence of Q wave in leads I, V5 and V6
  3. Monomorphic R wave in I, V5 and V6
  4. ST and T wave displacement opposite to the major deflection of the QRS complex
    Source

Dermatofibroma

Dermatofibroma.png

Keratocanthoma

keratocanthoma.png


Neurologic:


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The classic finding is subacute combined dengeneration (SACD) of the spinal cord.

[!INFO] What is 'combined'?

Signs



Thiazide diuretics bind to the chloride receptor of the Na-Cl cotransporter in the DCT and inhibit it's function causing urinary loss of Sodium and Chloride.


[!TIP] Mnemonic: TET
Like a "TET" spell
Triptans, erogatamine, Telcagepant
Acute -> Agonist (fewer letters, quicker to say)
- Verapamil - can cause headache on it's own but reduced migraine frequency.
- Cyproheptadine - 5HT2 receptor antagonist; also has antihistamine activity.


[!INFO] All Three sensory modalities affected!
Eyes, ears, Nose
RefsumDiseaseSlide.png

Anatomy of the CNIII nucleus

Cranial nerves in intracranial hypertension

The cranial nerves most commonly affected by intracranial pressure are the

  1. Abucent nerve (VI) - lateral rectus palsy
  2. Trochlear nerve (IV) - palsy of superior oblique
  3. Oculomotor nerve (III) - 'Down and out' pupil.
    Source

Mechanisms:

Abducens nerve

Causes of abducens nerve palsy:
Source
Source

abducensNerveCranialNerveVIfacialNerve.png

Source
Source
OneAndAHalfOAHSyndrome.jpg

Trochlear nerve



Carey coombs - Coombs for carditis



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1. All patients should be on aspirin and statin.

ACEi can be used to prevent ACS in aginal patients. Source


    - Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS > 160ms is associated with ventricular arrhythmias - passMedicine
- 

1. **Primary idiopathic**
2. **Primary immune complex mediated** - eg. Goodpasture's syndrome (Goodpasture's has less recurrence than GPA - PasTest answers); From the image above, *these are small vessel vasculitidies*. 
    5. Cryoglobulinaemic vasculitis (CryoVas)
    6. ?Behcet' disease
    7. 
  1. Secondary

[!INFO] The distinction between GCA and Takayasu is made mainly base on patients age!
Because histologically, they are very similar.

[!INFO] Diagnosis:
ESR and biopsy are very suggestive for PMR but both can be falsely negative!

- One of which is the **temporal artery**. 
- Other arteries: *ophthalmic*, *occipital*, **vertebral**, *posterior ciliary*
- Can also cause *mononeuritis mulitplex*. [Source](https://emedicine.medscape.com/article/316024-overview#showall)
- *However*, *ESR can be normal* in upto 20%; Therefore, normal ESR doesn't exclude GCA. 

Treatment: Corticosteroids +/- azathioprine.



[!INFO] Indications for defibrillation
"unstable" should be taken to mean any of the follwing:

  1. Shock
  2. Syncope
  3. Evidence of myocardial ischemia
  4. Heart failure (pulmonary oedema)

homogentisicMnemonic.png

gentisic -> gentleman -> black suit